CPB (Certified Professional Biller) Certification Practice Exam

Which Medicare reimbursement system was expanded in 2008 to include subclasses adjusting for severity of illness and risk of mortality?

1. All Patient Diagnosis-Related Group

2. All Patient Refined Diagnosis-Related Group

3. Ambulatory Payment Classification

4. Ambulatory Surgical Center Payment Rate

The correct answer is: All Patient Refined Diagnosis-Related Group

The correct answer is the All Patient Refined Diagnosis-Related Group (APR-DRG) system. This system was designed to enhance the original Diagnosis-Related Group (DRG) classification by incorporating additional factors that account for patient severity of illness and risk of mortality. By factoring in these subclasses, the APR-DRG system provides a more accurate reimbursement model that reflects the complexities and variations in patient care needs. The expansion in 2008 aimed to improve payment accuracy in hospitals by recognizing that patients with different comorbid conditions or varying severities of the same condition could have significantly different costs associated with their care. This allows for a more equitable distribution of resources and better financial support for hospitals serving higher acuity patients. The other options refer to different reimbursement systems that do not include specific adjustments for severity of illness or mortality risk in the same way that the APR-DRG system does. For instance, the Ambulatory Payment Classification system is designed for outpatient services, while the Ambulatory Surgical Center Payment Rate focuses on specific outpatient surgical services, neither of which appropriately addresses the complexities of inpatient hospital billing as the APR-DRG does.